10.1 Dementia, Alzheimer’s Disease, Delirium & Person-Centered Care

Dementia and Alzheimer’s disease

Dementia is a syndrome: decline in cognition severe enough to interfere with daily function. Memory, language, judgment, attention, visual-spatial ability, and motor planning may be affected. Alzheimer’s disease is a common progressive neurodegenerative cause, but vascular disease, Lewy body disease, frontotemporal degeneration, and mixed conditions produce different patterns.

Avoid the blanket statement that every “dementia” is permanently irreversible. Some medical, medication, mood, sensory, and metabolic conditions can mimic or worsen cognitive impairment and may improve when treated. The licensed team evaluates the cause. A nurse aide observes function and behavior, supports care, and reports change.

Alzheimer’s disease commonly progresses from difficulty learning new information and managing complex tasks to greater ADL dependence, language loss, wandering risk, swallowing difficulty, and eventually total care. Progression and symptoms vary; rigid three-stage labels are study aids, not exact predictions for every resident.

Delirium is different

Delirium develops over hours to days, fluctuates, and especially affects attention and awareness. A person may be restless and hallucinating or unusually sleepy and withdrawn. Causes include medication effects, dehydration, hypoxia, pain, constipation, urinary retention, metabolic disturbance, sleep loss, and many infections.

Delirium is a medical urgency and may improve when the cause is corrected, but “always reversible” is too absolute. Some residents recover incompletely or have serious outcomes. Report sudden change immediately, protect from falls, obtain assigned vital signs or observations, and describe onset and fluctuation.

Do not diagnose a UTI from acute confusion alone. Current guidance recommends assessment for other causes when an older adult has delirium and bacteriuria but lacks local urinary symptoms or systemic signs. The aide’s action is still prompt reporting—the correction is to avoid narrowing the cause prematurely.

Communication

Approach from the front, identify yourself, use the resident’s preferred name, and make eye contact without crowding. Give one concrete step at a time and allow processing time. Offer limited choices: “Would you like the blue shirt or green shirt?” Demonstrate the task and use hand-over-hand assistance only with consent and according to the plan.

Avoid arguing about an inaccurate statement. Validate the emotion without claiming to see or believe something you do not: “That sounds frightening. I do not see a man in the room, but I am here with you.” Gentle redirection to a familiar activity can reduce distress. Reality cues such as clocks and calendars help some people, especially during delirium recovery, but repeated correction that causes grief or humiliation is not therapeutic.

Behaviors communicate needs

Before labeling behavior, check for pain, hunger, thirst, toileting, constipation, temperature, fatigue, fear, noise, poor lighting, unfamiliar staff, missing glasses/hearing aids, and a changed routine. Report new aggression, withdrawal, sleepiness, hallucinations, or function loss.

• Sundowning: reduce late-day noise, provide light before shadows deepen, maintain routine, offer toileting and a calming familiar activity, and avoid caffeine near bedtime if restricted by the plan.
• Wandering: provide supervised safe walking and meaningful activity, maintain required door or alert systems, keep identification under policy, and never lock a person alone as punishment.
• Catastrophic reaction: stop the demand, lower stimulation, step back, speak calmly, and try later with help.
• Hallucination or delusion: acknowledge fear, check safety and sensory devices, do not debate or reinforce the false belief, and report new onset.
• Repetitive questions: answer patiently or use a visible cue; do not shame the resident for forgetting.

Maintain privacy and adult identity during total care. Break ADLs into manageable steps, preserve familiar preferences, and encourage every ability that remains. If behavior places someone in immediate danger, call for trained help and use the least restrictive response in the care plan.

Person-centered scenario

A resident suddenly resists a shower that was previously enjoyed. Treat “no” as communication. Pause, cover the resident, and check water comfort, pain with shoulder movement, fear of a new caregiver, bathroom noise, toileting need, and whether hearing aids or glasses are missing. Offer a familiar sequence or return later if safe, and report the new resistance. Do not label the resident “combative.”

Life history can guide redirection: a former teacher may enjoy sorting papers; a parent may fold towels; a gardener may water safe plants. The goal is not to trick the person but to offer recognizable purpose and reduce distress. Document which approaches helped so other staff can provide consistent care.